GLP-1RAs show promising translational potential for metabolic optimization in surgical prehabilitation

Major abdominal surgery often leads to significant postoperative complications, particularly in patients with obesity and type 2 diabetes. Prehabilitation is an established perioperative strategy to improve outcomes, focusing on optimizing patient health before surgery. However, current prehabilitation protocols often lack robust pharmacological interventions for metabolic optimization. The widespread use of GLP-1 receptor agonists (GLP-1RAs), such as semaglutide and tirzepatide, for weight loss and glycemic control presents a compelling opportunity to address these metabolic challenges and enhance surgical readiness.

This review systematically explored the potential role of GLP-1RAs as a pharmacological adjunct within multimodal surgical prehabilitation. The authors discussed the biological rationale for metabolic optimization, focusing on the relevance of sarcopenic obesity and its impact on surgical outcomes. They also examined potential implications for oncological surgery and neoadjuvant therapy, drawing insights from emerging data in bariatric and metabolic surgery. Furthermore, the review highlighted critical perioperative safety considerations, including delayed gastric emptying and aspiration risk, alongside current anesthetic guidance.

The review posits that GLP-1RAs offer a biologically plausible and clinically attractive strategy for metabolic optimization in surgical patients. Their known effects, including substantial and rapid weight loss and improved glycemic control, directly address key risk factors for surgical complications. The authors highlighted how GLP-1RAs could mitigate the adverse effects of sarcopenic obesity, potentially preserving lean muscle mass while reducing fat. They also discussed the relevance of these agents in the context of oncological surgery, where metabolic health can influence treatment response and recovery. Emerging data from bariatric and metabolic surgery further support the concept of using GLP-1RAs to improve patient readiness. However, the review also emphasized important safety considerations, such as delayed gastric emptying, which necessitates careful perioperative management and anesthetic adjustments.

Integration of GLP-1RAs into prehabilitation pathways is biologically plausible and clinically attractive, representing a promising and testable strategy for metabolic optimization in surgical patients.